In 1983, the Georgia Department of Human Resources' Office of
Epidemiology reviewed vital statistics data for 1979-1981 to better
define the problem of unintentional, burn-associated mortality.
Under
the International Classification of Diseases, 9th Revision (ICD-9),
unintentional thermal and chemical burns as external causes of
death
are specifically coded to "Accidents caused by fire and flames"
(ICD-9
rubrics E890-899) and "Accidents caused by hot substance or object,
caustic or corrosive material, and steam" (ICD-9 rubric E924).

During the 3-year study period, 731 deaths with underlying
causes
attributed to ICD-9 codes E890-899 and E924 occurred, indicating an
average annual death rate of 4.46/100,000 residents based on
Georgia's
1980 census population. By race, 49% of deaths occurred among
whites
and 51% among blacks; none occurred among other races. Decedents
were
male in 66% of all cases; 69% of whites were males, and 62% of
blacks
were males. The annual death rate was 2.1 times greater for males
than for females and 2.8 times greater for blacks than for whites
(Figure 1). The increased relative risk for males was
characteristic
of both racial groups, and the increased risk for blacks was
characteristic of both sexes.

By type of burning event, more than 80% of deaths were
attributed
to uncontrolled fires in private residences (Table 1). Males
dominated in all five cause categories, accounting for from 57% of
victims of clothing fires to 85% of victims of "other
conflagrations." Blacks accounted for 26% of the 53 victims of
"other
and unspecified fires" but from 50% to 58% of victims in the other
four categories. Of the 19 deaths from hot or caustic substances,
16
(84%) were specifically coded to hot liquids and vapors, as opposed
to
other substances or surfaces.

Age data available for 1980-1981 indicated that approximately
22%
of the 510 fatal burn victims were less than 20 years of age; 48%
were
20-64 years old; and 30% were 65 years of age or older. The
distribution of deaths by age varied with the type of causative
event. The proportion of victims aged 65 years of age or older,
for
instance, ranged from about 25% for residential fires to 67% for
hot
substance and chemical burns. Children under 10 years of age
accounted for 22% of deaths from residential fires and for 1% of
all
other types of burn-associated deaths. Although more
burn-associated
deaths occurred in the 20- to 64-year age group than in older or
younger age groups, age-specific death rates were higher in the
under-10 and 65-and-older age groups.

Age-specific rates were similar in pattern for both sexes and
both
races (Table 2) but were higher among blacks than among whites at
both
extremes of age and higher among males than among females for
adults
of both racial groups. All seven victims under 1 year of age were
black; six of these were female; and all seven died from
residential
fires. The pattern of race-, sex-, and age-specific death rates
from
residential fires was similar to that for all burn-associated
deaths,
with rates reaching 19.3 for black female infants; 15.5 for black
females and 16.1 for black males aged 1-4 years; and 16.4 for black
females and 64.9 for black males aged 75 years or older. Rates
were
5.5 at ages 1-4 and 8.6 at 75 years or older for white males and
4.4
at ages 1-4 and 5.1 at 75 years or older for white females. Deaths
were rare among children in the other categories of burn events,
where
numbers of deaths generally were small. Among adults, rates
generally
increased markedly with advanced age among blacks and males, but
specific patterns varied between race, sex, and cause groupings.
Reported by TW McKinley, MPH, RK Sikes, DVM, State Epidemiologist,
Georgia Dept of Human Resources; Div of Field Svcs, Epidemiology
Program Office, Special Studies Br, Chronic Diseases Div, Center
for
Environmental Health, CDC.

Editorial Note

Editorial Note: Each year in the United States, unintentional
burns
account for some 6,000 deaths (1) and 106,000 hospitalizations (2).
The crude mortality rate of 4.46/100,000 for Georgia is higher than
the national rates of 2.8 for 1978 and 2.4 estimated for 1980, as
reported by the National Safety Council (1). This difference is
consistent with relatively higher burn-associated death rates for
southern areas of the United States, as noted a decade ago (3), and
may reflect regional population differences in age, race, economic,
and residential characteristics--factors shown to influence
burn-associated mortality rates (3,4). Mortality data reflect only
a
small portion of the total burn problem, since incidence rates
reported for nonfatal, burn-associated injuries have ranged from 27
(4) to 150 (3) per 100,000 per year, based on hospital admissions
and
health survey data, respectively.

The distributions of persons and risks by age, sex, and race,
along with the dominance of house fires as a causative event, are
consistent with burn-associated mortality patterns reported earlier
in
national and New York State studies (3,4). Greater severity of
injuries associated with house fires than with other burn causes,
as
well as relatively increased dependency and frailty among persons
at
the extremes of age, may explain the age patterns. A relatively
higher degree of risk-taking behavior in males than in females,
including such fire-causing activities as smoking (4,5) and
careless
handling of flammable materials (3,4), may account for the
differences. Occupational hazards may also contribute to increased
risks for adult males. The higher relative risks for blacks are
likely to reflect socioeconomic differences. Although a threefold
excess morbidity risk was found for blacks in the New York study,
differences in income and education levels significantly
contributed
to county-specific differences in morbidity rates, while other
variables did not (4). House-fire deaths in Baltimore showed a
strong
correlation with economic status for both whites and blacks (5).

Further studies are needed to determine which of the observed
burn-associated deaths might be preventable through greater use of
currently available environmental or technologic measures, such as
residential smoke and fire alarms (4,5), flame-retardant materials
for
building construction and furniture upholstery (4),
self-extinguishing
matches and cigarettes (4-6), and lower temperature settings on
water
heater thermostats (6,7); through increased occupational safety
measures; or through educational or other behavioral change
activities. Since over 80% of Georgia's burn deaths occurred in
home
fires, significant decreases in annual mortality might be achieved
through programs designed to direct specific preventive measures
toward families at high risk.

All the potential intervention measures suggested above are
appropriate for reducing mortality. Those based on environmental
changes rather than changes in personal behavior are more direct,
however, and are considered more likely to succeed (6). Such
measures, which include installing residential smoke detectors and
reducing temperature settings of water heaters are appropriate for
immediate state and local intervention efforts and have been
recommended as part of community injury-prevention programs (8).

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